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HomeMy Public PortalAbout4840 GOLDEN WEST AVE_Building__ T T 7QA888A CE 80910-88 APPLICATION FOR BUILDING PERMIT I COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 1 CJ !l BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. ty-Q-'t_/ ✓ DISTRICT NO. QapL PTY E PR ESSED BY FOR APPLICANT TO FILL IN J- I I CONs BUILDING ., " � �{ STATISTICAL CLASSIFICATION I SEWER MAP -{ ADDRESS 19r�d 4 III •�6 57- CLASS.NO. f DWELL.UNITS BK PG �R'T i'Ln LO N BLOCK N MA ER�- ST YES NO TRACT USE ZONE SPECIAL � CONDITIONS SIZE OF LOT ,Z 4784 I NOW ON LOTS �j 7 - ( 4 Z _ USE OF A \ J EXISTING B i0VF ) { Q BUILDING YARD HWYSTREET NAME EXIST. SETBACK WIDTH OWNER o "ra n FRONT MAIL �+' P.L. �- -�J ADDRESS$�D©Lgs (; N A_g TEL 7 PID L. C, )s = NO. i INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS A TEL CONTRACTAft �y NO. �O ADDRESS O/F3_ . VA 4 DESCRIPTION OF WORK NEW VooeADD ALTER REPAIR DEMOLISH <- I SQ.FT. /� NO.OF NO.OF .�.,( SIZE r '',,tl�d� STORrIE./S USE OF tt FAMILIES` STRUCTURE D`�t%j-i-h I6 T Ir T T��j�GIJ s `� e SIGNAT APPL I OU APPROVALS DATE INSPECTOR'S SIGNATURE ADORES (' FFORMSNDATMATERIALS EION VALUATION$ J 5�� FRAME. FIRE STOPS. '7 BRACING,BOLTS F E S FEE ODI "� FURNACE:G S VENT,DUCTS LOCATION. I HE EBY A NOWLEDGE-T-IAT 1-t1AVE READ THIS AP- P1 ICATI D STATE THAT THE ABOVE IS CORRECT AND _ AGREE TO COMPLY WITH ALL COUNTY DIN ES ND STATE S REGULATIN BUILDIN UC ON. ATH,EXT. SIGNA HOUSE NUMBER COR- PERM RECT AND POSTED ADDRESlf FINAL t A CLYDE N. DIRLAM, PRINCIPAL ST UCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH .60Zj 3S FEB --4 2 ,3 A 21.404 . „IO, as4 0o150' FEB A 42.00 WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self A P P L I CATION 'FO R BUILDING PERMIT -insure;or a certificate of\Nork+~rs'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified co is hereby furnished. BUILDING 7 copy Y FOR APPLICANT'TO FILL IN ADDRESS � �= C�i l sT Certified copy is filed with the county.building inspec- BUILDING tion department. ADDRESS 'T7L1 ® ✓rte LOCALITY: .NEARE Date Applicant CIT �Y �/ ZIP `/ 7i D CROSS ST. / CERTIFICATE OF EXEMPTION FROM WORKERS' V NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK 9 PAGE+�-� PARCEL (This section need not be completed if the permit is for one USE ZONE FSPECIAL P hundred dollars ($100)or less.) TRACT BLOCK LOT NO. :Z . TEL.I certify that in the performance of the work for which this OWNER .�lp�f �//�S/�/fi ,�>� NO. ��.�2 NDITIONS t. permit is issued, I shall not employ any person in any manner ADDRESS 1 d Ted L;�PfIC(� DISTRICT GROUP TYPE FIRE P CESSED BY �_ �,//�,p�� Q ^ CONSI� ZONE W70 so as to become subject to the Work Co ensation Laws. /_�yy�� 31 � CITY 4/Yy `G�/ ZIP M",9aDate ® � Applic�iYR dG STATISTICAL CLASSIFICATION AT. CONDO NOTICE O APP.ICANT: If, after making this Certificate o ARCHITECT O TEL. r Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. TEL. BK PG, VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALU ION (commencing with Section 7000)of Division 3 of the Business and LIC. ff /'�� � Professions Code, and my license-is in full force and effect. CITY CLASS $ (� SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW El $ Contractor Date 7 ADD E]I am exempt under Sec. �� ALTER E] FINALt} B.&P.C. for this reason REPAIRRai DATE � Date: USE OF FINAL DEMOL EXISTING BLDG. By �� �� Signature APPLICANT / � TEL. �J OWNER-BUILDER DECLARATION PRINT) / d-, 1 r i(! 4i 0 NO.� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS # 0 0 0 0 0.1 Professions Code): PRESENT ® ® 0 0 aI, as owner of the property, or my employees with ADDRESS 1 wages as their sole compensation,Will do the work and LOCALITY ( o ® 3 0 0 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). . kADDRE TEL. I, as owner of the property, am exclusively contracting CTOR NO. 0 1.0 5 5,8 4.:c, with licensed contractors to construct the project (Sec- .10, 19-84 tion 7044, Business and Professions Code). ED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY CK YARD- HWY PROP. LINE WIDTH. ' I hereby affirm that there is a construction lending agency for T the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). m Lender's Name $ Permit Fee G a` o Lender's AddressI certify that I have read this application and state that the Issuance Feeabove information is correct. I agree to comply with.all County tion Fee ,01� S ordinances and State laws relating to building construction, Total Fee d and hereby authorize representatives of this County to enter �- up n�the above-mentioned property for inspection purposes. pGr/L� L� �p� Y SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature of Applicant or Agent Date Os